anesthesia fellowship in interogation

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MTGas2B said:
Something in the Hippocratic oath about using our powers for good?

That could be an issue.
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There is not such a think like Hippocratic oath. It is an "urban legend"...
 
MTGas2B said:
Something in the Hippocratic oath about using our powers for good?

That could be an issue.
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Here it is:

"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion."

We are pretty selective in our adherence to the oath. I'm not sure why physicians aren't involved in capital punishment when we are involved in abortion. I'm not arguing for one side or trying to start an argument, but pick a standard and stick to it.
 
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have you ever read the hippocratic oath? First off, you begin by swearing to the greek gods. it goes on to prohibit such activities as performing surgery and sleeping with the house slaves, be they male or female.

Don't think it really has ANY relevance to current medical ethics.
 
Pilot Doc said:
have you ever read the hippocratic oath? First off, you begin by swearing to the greek gods. it goes on to prohibit such activities as performing surgery and sleeping with the house slaves, be they male or female.

Don't think it really has ANY relevance to current medical ethics.
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Irrespective of what you think about the hippocratic oath, the AMA code of ethics is ethically inconsistent in forbidding participation in executions (and interogations presumably) while allowing participation in abortion. The side you agree with in this ethical dilema doesn't matter to me, but you can't be on both sides. They are both ok or neither is ok.
 
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dr doze said:
1. The oath is not legally binding.
2. Many medical schools at graduation do not administer the oath or administer an alternative oath.
3. My school did administer the oath, however administration told us simply not to recite any parts that we did not like.
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All true statements. All irrelevant to my argument though. I quoted the Hippocratic Oath becaue MTGas2B mentioned it and because it points out an ethical inconsistency in modern medicine that I find interesting and difficult to justify.
 
nolagas said:
All true statements. All irrelevant to my argument though. I quoted the Hippocratic Oath becaue MTGas2B mentioned it and because it points out an ethical inconsistency in modern medicine that I find interesting and difficult to justify.
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Absolutely - there is no ethic in the modern practice of medicine. We are bending by political trends.
 
So, I used to the Hippocratic oath to illustrate the general principle that a physician using medical knowledge and techniques would raise significant ethical red flags. I realize not everyone take the Hippocratic oath (I did), I also know that of those that do there are many versions floating around out there. The relevance in modern medicine is debatable. However, there are modern accepted standards in medical ethics that are very well accepted.

We could make a four box diagram of modern medical ethics and illustrate how this would not stand.
1. Autonomy Clearly if a patient is not willing to confess/discuss an issue pharmacologically forcing him/her to is violating his/her autonomy.

2. Beneficence (to do good, provide a benefit) Could go back and forth on this one, comparing societal good vs. good to the individual. I contend that subjecting someone to medical treatment/therapy with no intent benefit to the patient violates this principle.

3. Nonmaleficence (do no harm) Administering sedatives, "truth serums", or whatever is not without risk. This could be an issue depending on the methods you employ, I might grant you could minimize it. This would have to be settled if we debated specific regimens.

4. Justice I don't know where to go with this one. Currently, I don't know the legal standard of medical provider involvement in interrogation. I think it would probably violate 5th amendment rights. A suspect/detainee or whatever could be forced into unwillingly giving a confession he/she may not have been willing to give.

So there you go, I would contend the physician involvement in interrogation would violate modern medical ethical principles.
 
Interesting arguments have been made in favor of our participation in lethal injection. STP, Panc, K. Who usually administers these? Us.

Several instances of "botched" lethal injections where it appeared the pt was not unconscious when the panc and K were injected. It seems likely that if an anesthesiologist were participating, the risk of this occurence would fall. Many legal challenges in several states on this exact issue. Some prisoners/condemned have actually argued that to not use a board certified anesthesiologist to administer the lethal injection amounts to "cruel and unusual punishment."

If you were to have lethal injection administered, who would YOU want doing it? I would want an anesthesiologist.

By participating, are we "doing harm" or "providing comfort"? By refusing to participate are we permitting suffering?

The AMA has a position, but that does not mean it is correct, or that we need to abide by it.

I am not taking a position here, just providing food for thought/further discussion.

T
 
I would have no problems participating.....as long as the sodium pentathol goes in at least 15 minutes after the other drugs.



tucker27705 said:
Interesting arguments have been made in favor of our participation in lethal injection. STP, Panc, K. Who usually administers these? Us.

Several instances of "botched" lethal injections where it appeared the pt was not unconscious when the panc and K were injected. It seems likely that if an anesthesiologist were participating, the risk of this occurence would fall. Many legal challenges in several states on this exact issue. Some prisoners/condemned have actually argued that to not use a board certified anesthesiologist to administer the lethal injection amounts to "cruel and unusual punishment."

If you were to have lethal injection administered, who would YOU want doing it? I would want an anesthesiologist.

By participating, are we "doing harm" or "providing comfort"? By refusing to participate are we permitting suffering?

The AMA has a position, but that does not mean it is correct, or that we need to abide by it.

I am not taking a position here, just providing food for thought/further discussion.

T
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There was a panel discussion about this at the ASA meeting last month. The major point they brought up was this: Anesthesiologists are physicians and therefore practice medicine; Execution is not the practice of medicine nor is it compatible with the practice of medicine.

The association between lethal injection and anesthesiology would be damaging to the profession. As part of the ASA's awareness campaign, the new motto is "Anesthesiologists: Physicians providing the lifeline of modern medicine."

What would the motto be if the public associates the profession with lethal injection?
 
Prof Moriarty said:
There was a panel discussion about this at the ASA meeting last month. The major point they brought up was this: Anesthesiologists are physicians and therefore practice medicine; Execution is not the practice of medicine nor is it compatible with the practice of medicine.

The association between lethal injection and anesthesiology would be damaging to the profession. As part of the ASA's awareness campaign, the new motto is "Anesthesiologists: Physicians providing the lifeline of modern medicine."

What would the motto be if the public associates the profession with lethal injection?
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Though in Oregon there is ethical to practice assisted suicide. And I will say that anesthesiologists are more qualified to provide this "service". Doesn't mean that I agree with the idea of assisted suicide.
 
Physician-assisted suicide was discussed as well.

Primary differences noted: PAS honors patient autonomy and operates within the bounds of the doctor-patient relationship, whereas in the context of execution there is no autonomy and no "patient" per se.
 
Prof Moriarty said:
Physician-assisted suicide was discussed as well.

Primary differences noted: PAS honors patient autonomy and operates within the bounds of the doctor-patient relationship, whereas in the context of execution there is no autonomy and no "patient" per se.
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When we are coerced into getting flu shots there is no 'autonomy' either.
 
Prof Moriarty said:
Physician-assisted suicide was discussed as well.

Primary differences noted: PAS honors patient autonomy and operates within the bounds of the doctor-patient relationship, whereas in the context of execution there is no autonomy and no "patient" per se.
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You could argue that the criminal made an autonomous decision that led to the execution. Sure he doesn't consent to being executed now, but he put himself in that position with a decision that initiated the chain of events leading to the execution. It's kind of like a drunk driver being charged with manslaughter. Even though he didn't want to kill someone, he put himself in that position by choice.
It is also possible that, given that an execution is going to occur, the pain patient would consent to medical intervention vs the impending pain. If he won't consent to pain control, then Mil's panc, coffee break, pentothal method could be used. :scared:
 
nolagas said:
Not much. Lack of autonomy.
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I have a hard time believing that you seem to think that mandating flu shots translates to a serious infringement on autonomy. It infringes in obvious ways because it is a mandate but is it really that big of a deal? It is a public health issue.
 
Arch Guillotti said:
I have a hard time believing that you seem to think that mandating flu shots translates to a serious infringement on autonomy. It infringes in obvious ways because it is a mandate but is it really that big of a deal? It is a public health issue.
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My intern year the hospital decided to mandate seasonal flu shots for all employees. Those that refused would be forced to wear a mask. The nurse's union went balls out against this one in federal court, and won.

If I recall New York State did something similar this year with H1N1, but ended up backing off.
 
Arch Guillotti said:
I have a hard time believing that you seem to think that mandating flu shots translates to a serious infringement on autonomy. It infringes in obvious ways because it is a mandate but is it really that big of a deal? It is a public health issue.
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I shouldn't have mentioned it because I don't want to hijack this thread. To answer your question; It's not that it is such a big deal. It is that someone invades your body without your consent. Is the invasion major? no. Can you consent to a procedure when you are being coerced by your employer? No. A procedure without consent is assault. Lots of things could be argued for as public health issues but aren't permitted. Forced flu shots this year due entirely to media hype, not reality, isn't really ok even thoug it also isn't a huge deal. Incremental loss addds up.
 
nolagas said:
I shouldn't have mentioned it because I don't want to hijack this thread. To answer your question; It's not that it is such a big deal. It is that someone invades your body without your consent. Is the invasion major? no. Can you consent to a procedure when you are being coerced by your employer? No. A procedure without consent is assault. Lots of things could be argued for as public health issues but aren't permitted. Forced flu shots this year due entirely to media hype, not reality, isn't really ok even thoug it also isn't a huge deal. Incremental loss addds up.
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This thread was sort of worthless anyway😛.

I am a huge proponent of indivual liberties. But having to get a flu shot doesn't bother me at all. I get one every year anyway.

Why don't you just refuse it and wear a mask?:ninja:
 
Arch Guillotti said:
This thread was sort of worthless anyway😛.

I am a huge proponent of indivual liberties. But having to get a flu shot doesn't bother me at all. I get one every year anyway.

Why don't you just refuse it and wear a mask?:ninja:
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Arch - in NY is mandatory for healthcare workers to get the flu shot. So - you can wear a mask but you still get to be vaccinated. Otherwise you can lose your job.
Going back to the chemical interrogation - The Geneva Conventions prohibit chemical interrogation. But terrorists are not covered by the Geneva Conventions. I wouldn't have any problem to do it in a safe way for the subject.
"Posner elaborates in startling detail how U.S. interrogators used drugs—an unnamed "quick-on, quick-off" painkiller and Sodium Pentothal, the old movie truth serum—in a chemical version of reward and punishment to make Zubaydah talk. When questioning stalled, according to Posner, cia men flew Zubaydah to an Afghan complex fitted out as a fake Saudi jail chamber, where "two Arab-Americans, now with Special Forces," pretending to be Saudi inquisitors, used drugs and threats to scare him into more confessions."

http://www.time.com/time/magazine/article/0,9171,110103...
 
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Arch Guillotti said:
This thread was sort of worthless anyway😛.

I am a huge proponent of indivual liberties. But having to get a flu shot doesn't bother me at all. I get one every year anyway.

Why don't you just refuse it and wear a mask?:ninja:
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I already got the flu shot. I'm not opposed to the shot. I just don't think a consent is valid when you are coerced. Would you provide an anesthetic, interrogational or death penalty or otherwise, if the subject is being coerced / doesn't consent? That's the connection of vaccination to this thread, in my mind at least. I think that a criminal gave implied consent to the death penalty when he performed an act that results in capital punishment. I don't think you've given implied concent to receive treatments at the whim of your hospital when you decided to become a doctor.
 
I think you have missed a point. The lethal injection is going to occur, obviously without the condemned's consent. The issue is, who will administer it? The prisoner is requesting, in fact in some instances demanding an anesthesiologist. So I think pt autonomy does not come into play here.
On the other hand, being linked with LI is perhaps not the best public relations move.
But standing by and watching people suffer, while claiming it would be unethical for us to be involved and reduce the chance of suffering is ironic.
The bottom line is how do you define the practice of medicine?

These are all great issues to consider and debate, as have many before us. But short posts here aren't going to accomplish much.
Signing off
T
 
Dudes the ole tired capitol punishment debate with some abortion sprinkled in there? Come on you guys are better than that. Why in the f uck would anyone waste there breath on these topics? Leave it up to the high school debate teams and the lonely losers in the freshman dorms on a friday night who didn't get invited to the party...
 
Hockeyguy said:
Dudes the ole tired capitol punishment debate with some abortion sprinkled in there? Come on you guys are better than that. Why in the f uck would anyone waste there breath on these topics? Leave it up to the high school debate teams and the lonely losers in the freshman dorms on a friday night who didn't get invited to the party...
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This isn't a debate about capital punishment. It's a debate about anesthesiologists participating in it. It would appear to be timely. Here's the abstract from the panel discussion at last month's annual ASA meeting:

Execution by lethal injection: Does this differ from euthanasia and should physicians participate? With the recent Supreme Court ruling once again opening the door for execution via lethal injection and judicial demands that anesthesiologists participate, this session will examine the history of physician involvement in capital punishment, the medical, ethical, and legal implications of physician involvement in lethal injection, and a discussion of whether physicians should participate in executions via lethal injection. Given the discussion of physician participation in euthanasia, the discussion will compare euthanasia in a patient with a terminal disease to execution of a prisoner convicted of a capital offense.

Here's my solution: States with capital punishment should create an "executioner" job title (how about "capital punishment officer") and spell out the required training. This training could include key elements of anesthesiology training PLUS some additional hours specific to law enforcement, ethics, etc. ALSO, there should be some basic psychological testing to make sure people who sign up for this are emotionally stable. This approach would create 2 pathways: a longer one for the non-physician and a "short course" for anesthesiologists, who essentially get credit for their training. The bulk of the "extra" coursework for the latter group could probably be done online, and the rest at a weekend workshop, thus expediting the process for any anesthesiologist who would like to participate.

This way, when anesthesiologists participate in capital punishment, it would not be as an anesthesiologist per se, it would be as a "capital punishment officer". And therefore there would be no blurring of the practice of medicine and less impact on the public perception of anesthesiology.
 
Prof Moriarty said:
Here's my solution: States with capital punishment should create an "executioner" job title (how about "capital punishment officer") and spell out the required training. This training could include key elements of anesthesiology training PLUS some additional hours specific to law enforcement, ethics, etc. ALSO, there should be some basic psychological testing to make sure people who sign up for this are emotionally stable. This approach would create 2 pathways: a longer one for the non-physician and a "short course" for anesthesiologists, who essentially get credit for their training. The bulk of the "extra" coursework for the latter group could probably be done online, and the rest at a weekend workshop, thus expediting the process for any anesthesiologist who would like to participate.

This way, when anesthesiologists participate in capital punishment, it would not be as an anesthesiologist per se, it would be as a "capital punishment officer". And therefore there would be no blurring of the practice of medicine and less impact on the public perception of anesthesiology.
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Uh, dude this is nuts🙁.

Let me get this straight, you want to create an online course so that anesthesiologists can EXECUTE people?

"No blurring of the practice of medicine"? So we take an online course, go execute someone and there isn't a problem? We can just hang up our anesthesiologist hat at the door to the prison and magically become "capital punishment officer"?

Your "solution" blurs things even more. We should stay far away from this one.
 
Prof Moriarty said:
This isn't a debate about capital punishment. It's a debate about anesthesiologists participating in it. It would appear to be timely. Here's the abstract from the panel discussion at last month's annual ASA meeting:

Execution by lethal injection: Does this differ from euthanasia and should physicians participate? With the recent Supreme Court ruling once again opening the door for execution via lethal injection and judicial demands that anesthesiologists participate, this session will examine the history of physician involvement in capital punishment, the medical, ethical, and legal implications of physician involvement in lethal injection, and a discussion of whether physicians should participate in executions via lethal injection. Given the discussion of physician participation in euthanasia, the discussion will compare euthanasia in a patient with a terminal disease to execution of a prisoner convicted of a capital offense.

Here's my solution: States with capital punishment should create an "executioner" job title (how about "capital punishment officer") and spell out the required training. This training could include key elements of anesthesiology training PLUS some additional hours specific to law enforcement, ethics, etc. ALSO, there should be some basic psychological testing to make sure people who sign up for this are emotionally stable. This approach would create 2 pathways: a longer one for the non-physician and a "short course" for anesthesiologists, who essentially get credit for their training. The bulk of the "extra" coursework for the latter group could probably be done online, and the rest at a weekend workshop, thus expediting the process for any anesthesiologist who would like to participate.

This way, when anesthesiologists participate in capital punishment, it would not be as an anesthesiologist per se, it would be as a "capital punishment officer". And therefore there would be no blurring of the practice of medicine and less impact on the public perception of anesthesiology.
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Excellent idea!
 
Arch Guillotti said:
Uh, dude this is nuts🙁.

Let me get this straight, you want to create an online course so that anesthesiologists can EXECUTE people?

"No blurring of the practice of medicine"? So we take an online course, go execute someone and there isn't a problem? We can just hang up our anesthesiologist hat at the door to the prison and magically become "capital punishment officer"?

Your "solution" blurs things even more. We should stay far away from this one.
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No Arch, anesthesiologists can already execute people. Furthermore, some states mandate their involvement.

There are arguments out there on both sides of the issue. But that doesn't change the fact that state legislatures can write physician participation into law. The idea I proposed is an alternative.

The ASA and AMA have clear admonitions against being involved. But as you can see even just on this thread, there are anesthesiologists (and surely other physicians) ready and willing to participate. So whether you and I think an anesthesiologist should be involved or not, it won't stop someone else from participating. And as things are, they would be participating as an anesthesiologist.

So I'm trying to think outside the box. Why not call this person not by their physician title - assuming we agree this is outside the practice of medicine - and create a new title for them. Surely there is something extra they need to know, so provide a course and a certification as something other than a physician.

As one of the authors in the links below notes: "As disturbing as it is to discuss this issue, growing controversy does not allow us to ignore it."

See:

http://www.mayoclinicproceedings.com/content/82/9/1043.2.full

http://www.sciencedaily.com/releases/2008/01/080102232615.htm
 
Prof Moriarty said:
No Arch, anesthesiologists can already execute people. Furthermore, some states mandate their involvement.
Click to expand...

Good one, you got me🙄.

Could you provide a link for the states that mandate anesthesiologist involvement in executions? I interpret mandate as being actively involved in the execution, not just advising.

I understand the argument from the other side and I find that it has a lot of merit. I just don't agree with it. I agree with the AMA and ASA.

It can be a huge cluster if an execution is botched (by any manner). Having an anesthesiologist involved may reduce botchings.


I think that our involvement is fraught with ethical problems and is terrible PR for the profession.

Everyone loves to talk a big game on the internet. I doubt anybody on this board would actually participate in an execution if they could.
 
Arch Guillotti said:
Good one, you got me🙄.

Could you provide a link for the states that mandate anesthesiologist involvement in executions? I interpret mandate as being actively involved in the execution, not just advising.

I understand the argument from the other side and I find that it has a lot of merit. I just don't agree with it. I agree with the AMA and ASA.

It can be a huge cluster if an execution is botched (by any manner). Having an anesthesiologist involved may reduce botchings.

I think that our involvement is fraught with ethical problems and is terrible PR for the profession.

Everyone loves to talk a big game on the internet. I doubt anybody on this board would actually participate in an execution if they could.
Click to expand...

Sorry Arch, wasn't meaning it like that. Got big respect for you and your opinion. Was just trying to answer the question you posed to me.

It's a difficult topic. I propose this option as an alternative to mandating physician involvement.

From the Mayo Clinic link above:
"Specifically, because of recent botched lethal injections, judges in California and North Carolina have ordered the direct participation of anesthesiologists in lethal injections."

Came across these interesting articles hot off the press:
1- http://www.dispatchpolitics.com/liv...TION.ART_ART_11-14-09_A1_U5FLT9O.html?sid=101
2- http://standdown.typepad.com/weblog/lethal_injection/
 
Arch Guillotti said:
Good one, you got me🙄.

Could you provide a link for the states that mandate anesthesiologist involvement in executions? I interpret mandate as being actively involved in the execution, not just advising.

I understand the argument from the other side and I find that it has a lot of merit. I just don't agree with it. I agree with the AMA and ASA.

It can be a huge cluster if an execution is botched (by any manner). Having an anesthesiologist involved may reduce botchings.


I think that our involvement is fraught with ethical problems and is terrible PR for the profession.

Everyone loves to talk a big game on the internet. I doubt anybody on this board would actually participate in an execution if they could.
Click to expand...

you're wrong................again.
 
Prof Moriarty said:
Sorry Arch, wasn't meaning it like that. Got big respect for you and your opinion. Was just trying to answer the question you posed to me.

It's a difficult topic. I propose this option as an alternative to mandating physician involvement.

From the Mayo Clinic link above:
"Specifically, because of recent botched lethal injections, judges in California and North Carolina have ordered the direct participation of anesthesiologists in lethal injections."

Came across these interesting articles hot off the press:
1- http://www.dispatchpolitics.com/liv...TION.ART_ART_11-14-09_A1_U5FLT9O.html?sid=101
2- http://standdown.typepad.com/weblog/lethal_injection/
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you respect someone who is left winged...and believes in censorship.?????
 
militarymd said:
you respect someone who is left winged...and believes in censorship.?????
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IMHO, Arch is a great mod. Being a moderator doesn't mean you don't get to have an opinion. And someone's gotta provide a counterpoint on this forum to make it... "fair and balanced". :laugh:
 
Uh, riggghhhhhhhtttttttttt...............🙄

I find it a shame that a guy as smart as yourself can have such a limited (if any at all) appreciation for viewpoints of others.


militarymd said:
geez ....how many times can you be wrong in a single thread.
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Arch Guillotti said:
Uh, riggghhhhhhhtttttttttt...............🙄

I find it a shame that a guy as smart as yourself can have such a limited (if any at all) appreciation for viewpoints of others.
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affirmative action

yeah right...you mean ....I can't cut it like the rest...so give me a break...sort of like our president

I'm glad you got your fellowship....the "american way"...
 
Prof Moriarty said:
From the Mayo Clinic link above:
"Specifically, because of recent botched lethal injections, judges in California and North Carolina have ordered the direct participation of anesthesiologists in lethal injections."
Click to expand...

North Carolina had to postpone lethal injections for a while because they couldn't get anyone to perform them. (I can't remember the actual numbers, but I think it was something like no deaths for 2 years because no doctor would participate.)

It made me proud.
 
error404 said:
North Carolina had to postpone lethal injections for a while because they couldn't get anyone to perform them. (I can't remember the actual numbers, but I think it was something like no deaths for 2 years because no doctor would participate.)

It made me proud.
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Low supply, high demand... interesting 😀
 
error404 said:
North Carolina had to postpone lethal injections for a while because they couldn't get anyone to perform them. (I can't remember the actual numbers, but I think it was something like no deaths for 2 years because no doctor would participate.)

It made me proud.
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Do you need a NC license?:meanie:
 
2win said:
Do you need a NC license?:meanie:
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I'm not sure. But I do remember there being a little more drama to it-- like the state medical board saying they were against it-- making it so any doc who volunteered would definitely be in a negative spotlight.

I worked as a vet tech and have euthanized my share of sick animals. I don't think it befits us as physicians to calculatedly take someone's life when we're not improving it.
 
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